CMS’ Anti-Kickback Statute prohibits gifts in exchange for referrals. But in some cases, what qualifies as a gift might not be clear. In fact, some things that qualify might not be actual gifts at all.
A policy that UnitedHealthcare was poised to roll out that would have allowed it to retroactively deny ED claims isn’t moving forward yet. But that doesn’t mean case managers shouldn’t prepare for the payer, or others, to implement such policies.
Case managers need to prepare for a post-public health emergency world by understanding how to continue to work with and transition patients with COVID-19.
CMS announced another round of changes to its Bundled Payments for Care Improvement program recently and said that while participation thus far has been voluntary, it may become mandatory starting as early as 2024.
